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The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together.To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR).We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown.The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively.The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM.

Introduction It is acknowledged that secondary prevention for patients at high cardiovascular risk is suboptimal. Data from EUROASPIRE V registry showed that less than 50% of cardiovascular risks factors were controlled in this population. Purpose “Actua” study was designed to identify potential gaps regarding secondary prevention for patients at very-high cardiovascular risk. The main objective was to assess differences between scientific evidence and clinical practice through an agreement/disagreement analysis of a questionnaire with statements based on clinical guidelines and expert recommendations. Methods A qualitative analysis based on Delphi methodology was conducted. The study was divided into 2 phases. In phase 1, doctors were asked to show agreement or disagreement with the statements presented by the scientific committee through a Likert 5-points-scale. Consensus was stablished according to consensus method of Tastle. Results were expressed as a percentage (%CNS) which shows power of agreement or disagreement consensus. CNS>70% were considered as consensus. In phase 2, same doctors were asked again about the statements with no consensus or high dispersion in previous phase, after disclosing results in phase 1. In addition, a third questionnaire was conducted to asses socio-demographic data of the sample. Results 246 and 265 questionnaires were conducted in phase 1 and 2 respectively. 90% of respondents in phase 1 and 94,3% in phase 2 answered all the questions. Statements which showed consensus among participants are represented in table 1. As reported, there was consensus in goals for blood pressure ( Conclusion Doctors admitted that complex recommendations and lack of following-up were the main causes of low adherence to treatment among patients at high cardiovascular risk. Limitations The study was conducted following recommendations from 2016 ESC/EAS guidelines for the management of dyslipaemias. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Grupo Ferrer Internacional, S.A. Table 1. Questions phase 1Table 2. Questions phase 2

Superficial vein thrombosis of the lower limbs used to be considered a benign condition with a self-limiting clinical course. It is now known that its potential complications can be serious or even fatal, such as deep vein thrombosis or pulmonary thromboembolism. There are different forms of clinical presentation, risk factors and different treatments for its approach, mainly in Primary Care. The Vascular Diseases Working Group of the Spanish Society of Primary Care Physicians (SEMERGEN) has developed this update using current scientific evidence and jointly with the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery.

El nuevo coronavirus (SARS-CoV-2) es el responsable de un síndrome respiratorio agudo severo (SARS). Entre sus manifestaciones puede desarrollar una enfermedad trombótica, tanto venosa como arterial, debido a la inflamación excesiva que afecta al sistema vascular, con activación plaquetaria y disfunción endotelial, entre otros mecanismos. La trombosis se asocia a la infección producida por el SARS- CoV-2, aumentando su gravedad y confiriendo un peor pronóstico. Nuestra actuación como médicos de Familia puede aportar acciones importantes en el manejo y control de esta severa complicación. Teniendo en cuenta que muchos de nuestros pacientes ya reciben terapia antitrombótica o anticoagulante, el hecho de que puedan desarrollar una infección por COVID-19 tendrá implicaciones para la elección, la dosificación y el control en su tratamiento. En este documento, revisamos, con la información actualmente disponible, la relación entre enfermedad producida por el SARS-CoV-2 y trombosis, así como su manejo con un enfoque centrado en Atención Primaria.

Objective To determine the prevalence of hypotension and associated factors in hypertensive patients treated in the Primary Care setting. Materials and methods A cross-sectional, descriptive, and multicentre study was conducted with a total of 2635 general practitioners consecutively including 12,961 hypertensive patients treated in a Primary Care setting in Spain. An analysis was performed on the variables of age, gender, weight, height, body mass index, waist circumference, cardiovascular risk factors (diabetes, dyslipidaemia, smoking, obesity, sedentary lifestyle), fasting plasma glucose, complete lipid profile, as well as the presence of target organ damage (left ventricular hypertrophy, microalbuminuria, carotid atherosclerosis) and associated clinical conditions. Hypotension was defined as a systolic blood pressure less than 110 mmHg or a diastolic blood pressure less than 70 mmHg. A multivariate analysis was performed to determine the variables associated with the presence of hypotension. Results The mean age was 66.2 years, and 51.7% of patients were women. The mean time of onset of hypertension was 9.1 years. A total of 13.1% of patients (95% confidence interval 12.4–13.6%) had hypotension, 95% of whom had low diastolic blood pressure. The prevalence of hypotension was higher in elderly patients (25.7%) and in those individuals with coronary heart disease (22.6%). The variables associated with the presence of hypotension included a history of cardiovascular disease, being treated with at least 3 antihypertensive drugs, diabetes, and age. Conclusions One out of 4–5 elderly patients, or those with cardiovascular disease, had hypotension. General practitioners should identify these patients in order to determine the causes and adjust treatment to avoid complications.

Superficial vein thrombosis of the lower limbs used to be considered a benign condition with a self-limiting clinical course. It is now known that its potential complications can be serious or even fatal, such as deep vein thrombosis or pulmonary thromboembolism. There are different forms of clinical presentation, risk factors and different treatments for its approach, mainly in Primary Care. The Vascular Diseases Working Group of the Spanish Society of Primary Care Physicians (SEMERGEN) has developed this update using current scientific evidence and jointly with the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery.

Resumen Introduccion La claudicacion intermitente ( CI ) es frecuente entre la poblacion occidental, incluida la espanola; sin embargo, sus caracteristicas no son bien conocidas. El objetivo del estudio es conocer el perfil de los pacientes espanoles con CI. Material y metodos Estudio prospectivo, observacional, transversal, multicentrico y no aleatorizado sobre 1.641 claudicantes, divididos en 2 grupos: a) angiologia y cirugia vascular (ACV) (n = 920), y b) atencion primaria (MAP) (n = 721). Los pacientes fueron sometidos a un cuaderno de recogida de datos (CRD), analitica, indice tobillo/brazo (ITB), cuestionario Walking Impairment Questionaire (WIQ) y cuestionario europeo de calidad de vida (EQ-5D). Resultados Fueron varones el 75,3%, de 68,3 ± 9,4 anos, destacando sobremanera el elevado numero de factores de riesgo cardiovascular y enfermedades asociadas (fundamentalmente cardiacas), mas frecuente en el grupo ACV. El ITB de la serie 0,66 ± 0,19, inferior en grupo ACV (p = 0,001). Los porcentajes WIQ fueron: danos motores (48,57 ± 20,12), distancia (35,09 ± 25,73), velocidad (36,18 ± 22,83) y escaleras (41,76 ± 27,62), peores en lo relativo a los danos motores (p Conclusiones Los pacientes espanoles con CI presentan 3 caracteristicas: alto riesgo cardiovascular, limitada capacidad para el ejercicio e importante reduccion de la calidad de vida. Existen diferencias entre grupos, dado que los ACV tratan pacientes con enfermedad mas avanzada.

Resumen Introduccion La evaluacion de la insuficiencia venosa cronica (IVC) puede medirse mediante escalas de gravedad venosa. Sin embargo, los factores individuales que la condicionan no estan bien descritos. El objetivo del estudio es conocer las caracteristicas sociodemograficas y clinicas de una muestra de pacientes portadores de IVC para permitir la busqueda de los factores que incrementan la gravedad de la misma. Material y metodo Estudio promovido por la Sociedad Espanola de Angiologia y Cirugia Vascular en colaboracion con otras sociedades cientificas espanolas sobre 1.560 pacientes con IVC y a los que se han aplicado 2 instrumentos: clasificacion clinica CEAP y Venous Clinical Severity Score (VCSS). Resultados La distribucion de pacientes por estadios clinicos fue: C0, 3,3%; C1, 15,6%; C2, 21,0%, C3, 22,9%; C4, 23,6%; C5, 8,7%; C6, 4,5%. La puntuacion VCSS para toda la cohorte fue de 0,89 ± 0,53, siendo superior a la media en 4 de los 10 atributos medidos: dolor (1,59 ± 0,75), venas varicosas (1,80 ± 0,74), edema (1,40 ± 0,89), y pigmentacion (1,05 ± 0,98). A mayor CEAP le corresponde mayor puntuacion VCSS. En el analisis por subgrupos destacan como factores de gravedad el genero, varon, edad, peso, sedentarismo, antecedentes personales y familiares de enfermedad venosa. En el analisis de regresion multiple, los determinantes fundamentales de gravedad son: 1) edad; 2) antecedente de trombosis venosa superficial o profunda, y 3) peso del paciente. Conclusiones Existe una relacion positiva entre CEAP y VCSS. El analisis por subgrupos define factores fuertes y debiles de gravedad, que quedan clarificados mediante regresion multiple.

Introduccion El objetivo de este estudio fue analizar el control de la presion arterial (PA) y los factores asociados al mal control en una amplia muestra de hipertensos espanoles ≥ 65 anos. Material y metodos Estudio transversal realizado en Atencion Primaria en hipertensos tratados farmacologicamente. La PA se midio siguiendo normas estandarizadas y se considero bien controlada cuando era Resultados Se incluyeron a 5.385 pacientes (edad media 73,4 ± 5,9 anos; 58,5% mujeres). El 38,3% recibia monoterapia antihipertensiva y el 61,7% terapia combinada. El 38,2% (intervalo de confianza [IC] 95%, 36,9-39,5) mostro buen control de PA sistolica y diastolica. El control de PA fue mejor por las tardes que por las mananas (p Conclusiones Solo tres de cada 10 hipertensos ≥ 65 anos tienen adecuadamente controlada la PA. La diabetes hace 4 veces mas probable el mal control tensional y la percepcion del medico de buen control multiplica por 60 la probabilidad de que no se modifique el tratamiento en los pacientes mal controlados.

El proyecto PRESCAP presenta, hasta el momento, dos estudios transversales y multicentricos que se realizaron en los anos 2002 y 2006 con la misma metodologia y en poblaciones similares asistidas en Atencion Primaria (AP). Incluyeron pacientes ≥ 18 anos diagnosticados de hipertension arterial (HTA) de todo el territorio espanol que recibian tratamiento farmacologico antihipertensivo. El grado de control de la presion arterial (PA) que se ha encontrado en estas dos muestras, las mas amplias de las realizadas hasta ahora en nuestro pais, fue del 36,1% en 2002 y del 41,4% en 2006; estos porcentajes fueron respectivamente del 33,5% y 38,2% en los hipertensos de 65 o mas anos de edad, y del 9,1% y 15,1% en pacientes diabeticos. El 51,9% de los hipertensos presentaba riesgo cardiovascular (RCV) anadido alto o muy alto. El control de la PA disminuia conforme aumentaba el RCV: resultaba del 27,4% en los hipertensos que tenian RCV anadido alto y del 6,8% en los que mostraban RCV anadido muy alto. El medico de AP modifico el tratamiento de los hipertensos mal controlados en el 18,3% de los casos en 2002 y en el 30,4% en 2006. En el PRESCAP 2002 el 44,0% de los hipertensos recibia terapia combinada antihipertensiva y en el PRESCAP 2006 ese porcentaje ascendia al 55,6%. Aunque el control de la HTA ha mejorado ostensiblemente en Espana en los ultimos anos, el porcentaje de pacientes controlados optimamente sigue siendo todavia a todas luces deficitario, especialmente en la poblacion diabetica, en los hipertensos de mayor edad y en aquellos que tienen un RCV anadido alto o muy alto.

Objetivos Es necesario tener mayor informacion sobre el grado de control de la hipertension arterial y de otros factores de riesgo cardiovascular en condiciones reales de la practica clinica, lo que incluye considerar prioritariamente a la poblacion de alto riesgo de padecer eventos cardiovasculares. Los objetivos de este estudio fueron conocer el grado de control optimo de la hipertension arterial y de otros factores de riesgo cardiovascular en una amplia muestra de pacientes de alto riesgo espanoles asistidos en Atencion Primaria, y determinar los principales factores asociados al mal control. Metodos Estudio transversal realizado en pacientes de 55-75 anos con alto riesgo de padecer enfermedad cardiovascular. Se considero paciente de alto riesgo al que tenia antecedents de enfermedad cardiovascular previa (enfermedad coronaria y/o vascular cerebral y/o vascular periferica y/o insuficiencia cardiaca), diabetes mellitus y/o insuficiencia renal. Se midio la presion arterial siguiendo normas estandarizadas y se considero control optimo a las cifras inferiores a 140/90 mmHg (en diabeticos inferiores a 130/80 mmHg). Igualmente, se considero control lipidico optimo a los valores de colesterol total inferiores a 200 mg/dl, de colesterol HDL superiors a 40 mg/dl, de colesterol LDL menores de 100 mg/dl y de trigliceridos por debajo de 200 mg/dl. Resultados Se incluyeron 2.142 pacientes (53,4% hombres), con una edad media (DE) de 65,7 (6,6) anos. Mil doscientos setenta pacientes tuvieron antecedentes personales de enfermedad cardiovascular, 1.341 de diabetes mellitus y 23 de insuficiencia renal. Se observo hipertension arterial en el 82,6% (IC 95%: 81,0-84,2) e hipercolesterolemia en el 62,5% (IC 95%: 60,4-64,5) de los pacientes. Se encontro control optimo de la presion arterial en el 23,7% de los hipertensos (IC 95%, 21,4-25,7) y en el 7,1% (IC 95%: 5,9-8,1) de los diabeticos. Se hallo control optimo del colesterol total en el 30,0% (IC 95%: 28,1-32,0), de lipoproteina de baja densidad en el 9,3% (IC del 95%: 8,0-10,6), de lipoproteina de alta densidad en el 75,3% (IC 95%: 73,4-77,2), de los trigliceridos en el 82,8% (IC 95%: 81,2-84,4) y lipidico total en el 6,5% (IC 95%: 4,9-7,2). El mal control de la hipertension arterial se relaciono conla diabetes mellitus y la obesidad, y el mal control lipidico total con la insuficiencia renal y la edad. Conclusion El control de la hipertension arterial y de la hipercolesterolemia en la poblacion de alto riesgo cardiovascular atendida en Atencion Primaria es muy bajo. Probablemente estos datos reflejen la situacion actual de la prevencion cardiovascular en Espana.

Chronic venous disease (CVD) is a well-defined and known disorder which impact on related-health quality of life (QoL). However, individuals factors which determinate quality of life on CVD are not well defined. The purposes of this study were to describe the QoL in patients with CVD and examine socio-demographical and clinical factors which influence QoL METHODS: One thousand five hundred sixty patients with CVD were evaluated. We calculated for each patient two disease-specific severity scores: The "C" grade (clinical) of the CEAP classification and the Venous Clinical Severity Score (VCSS). Additionally, two QoL questionnaires were recorded: Short-Form Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Two multivariate logistic regression analyses (SF-12 and CIVIQ-20 model) were conducted to determine whether demographic and clinical variables were independently associated with QoL.Both QoL questionnaires indicated that the QoL decreased significantly (P0.05) as the C grade of CEAP increased. Each increase of 0.10 in VCSS score represented 2% worsening in QoL as measured by CIVIQ-20. Three factors were strongly associated with poor QoL on SF-12: increasing age, prior superficial venous thrombosis (SVT) or prior deep venous thrombosis. In the specific disease CIVIQ-20 questionnaire three factors (higher age, prior SVT and higher weight) were strongly associated with decrease QoL.Increasing disease severity by VCSS is associated with reductions in QoL. Subgroup analysis indicates that there are several significant individual determinants of worsening QoL.

Objectives Chronic venous disease (CVD) is a frequent disorder with a high socioeconomic impact. Little is known about the possible differences between healed ulcer (C5 group) and active ulcer (C6 group) in terms of disease severity and quality of life (QoL). Our aim was to determine the possible differences in severity disease and QoL between the C5–C6 and C1 (control) group. Methods Data from a national, multicentre, observational and cross-sectional study ( n = 1598) were used to compare three groups of CVD: C1 ( n = 243), C5 ( n = 136) and C6 ( n = 70). CVD severity was assessed with the Venous Clinical Severity Score (VCSS) and QoL with the Short Form 12 Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Results Patients with active ulcers had a higher mean total VCSS than patients with healed ulcers ( P < 0.05). Both SF-12 and CIVIQ-20 QoL questionnaires indicated a poorer QoL in patients with ulcers than in those with C1 ( P < 0.05). Compared with the C5 group, patients with active ulcers (C6) had lower QoL scores, but the differences were not statistically significant. Conclusions Patients with venous leg ulcers (C5–C6) are associated with high severity and poor QoL. However, the healing of a leg ulcer did not contribute to improvement of QoL.